vet app this wed/loss of balance

Question
QUESTION: Hi Dana,
You were of great help before on another rabbit, Chance, specifically in helping me know what to ask my vet and how to ask it.   I have an app. on wednesday at 4:30.  

The bunny in question is 5-7 yrs maybe 5 pounds, they are indoor bunnies.  He, Sterling is showing a loss of balance.  It seems primarily to be from a weakness in the right hind leg.  I have also noticed urine in areas outside of the potty box that have never been soiled before.    He is also for the past few months having softer cecums then was typical for him.    There is no sign at this time of head tilt, or unusual eye movements, or circling.    

I did e-mail etherbun and EC was brought up.   It will take time to get results for the titer.   Would it be good to go head and treat with Panacure?        I usually have some paste on hand for treating dogs, the paste I use is 290 g paste 10%(100mg/g).    What about the other bunnies that he is around?

I want to take that seriously but not dismiss other possibilities.  

2-maybe 3 months ago it seemed he stumbled out of his cage.  It is open so they can go in and out.   I checked  him out and he seemed fine.   It makes me wonder if something mechanical happened or was it the beginning of this loss of balance/weakness in the hind leg.

What would be good questions to ask the vet?

What would be good tests to consider first in ruling things out or in?      

I was also encourage to check out a link on medibun.  Some of the things mentioned in the link are:
Injury to back or spinal cord/ Would an x-ray show that.   The bunny does not seem sensitive to touch.   He is interested in what I am doing when I pet his hindquarters but does not flinch or move away.       He does not appear to grind his teeth in pain or hunker down unwilling to move.   He still seems alert, eating well, drinking.  He does not appear underweight or overweight.   He does walk more than he hops.  Does that tell me anything?

Abnormal electrolytes-- How do you check for that?

Infection -- White blood count?

Brain cancer or infections

EC or other parasite including toxaplasma  

Floppy Rabbit Disease--what is that?

My funds are limited so where do I begin.  Where to focus my resources in ruling things out?

I look forward to hearing from you.

Thanks Terri

ANSWER: Dear Terri,

If it walks like a duck and quacks like a duck...

All the signs you describe:  hind limb weakness, loss of good litterbox habits, no pain, etc. are consistent with Encephalitozoon cuniculi.  In truth, I would not waste money on titer blood tests, since they will not give you conclusive answers about this.  But I would ask the vet about putting your bunny on fenbendazole and/or toltrazuril to prevent further degeneration of his condition.

"Abnormal electrolytes-- How do you check for that?"

This isn't likely if the condition is chronic, but would be tested with a blood test.

"Infection -- White blood count?"

Again, you'd see more signs of trouble if this was an infection, though I would not rule it out.  White blood count is also done via blood test.  But taking the bunny's temperature is a quick, simple way to know what's going on in that regard:

www.bio.miami.edu/hare/sickbun.html

"Brain cancer or infections"

Really uncommon, but not impossible.

"EC or other parasite including toxaplasma"

Ec very common; toxoplasma....not so much.

If your funds are limited, I would simply ask the vet about putting bun on Panacur (fenbendazole) or oxibendazole (NOT albendazole) and ponazuril/toltrazuril to arrest the problem if it's E. cuniculi.  We have had excellent results by combining the two drugs, but what to do will be best left to your vet.

I hope this helps.

Dana

Floppy Rabbit Disease--what is that?

---------- FOLLOW-UP ----------

QUESTION: I gave my vets info on ponazuril/toltrazuril.  They did not carry it at that time.  I will double check.   Where can I find this if they don't carry it?

Does it require a prescription?

Also, do I need to treat the other bunnies that share the area?  They have certainly been exposed to Sterling's urine.     

Terri

Answer
Dear Terri,

Here is the least expensive toltrazuril I found:

http://www.horseprerace.com/bayer-baycox-toltrazuril-200ml-p-29.html

It appears that no prescription is needed for this, but if you buy it as Marquis (ponazuril), then you do need a prescription:

http://www.prokennel.com/marquiseach127gmtube.aspx

Thing about E. cuniculi is:  some rabbits will harbor it all their lives and never show clinical signs.  Others may start to show signs as they age, or if they become immunocompromised for some other reason.  Also, there is no guarantee that prophylactic treatment now will prevent signs in the future.  We just don't know enough about it yet.

That said, if these were my bunnies I would ask the vet about putting all of them on a 30-day course of ponazuril and Panacur.  Better safe than sorry.  The entire area should also be disinfected with 10% bleach solution once the bunnies have been on the meds for about a week (and so are less likely to be shedding viable cysts), and everything laundered and dried very thoroughly at hot temperatures.

Hope all will be fine soon!

Dana